KKR is an existing backer of BrightSpring, which had a share price of $13.85 as of market close on Friday.

Based in Louisville, BrightSpring provides home- and community-based pharmacy and health care services for complex populations. It offers home care, home health care and home-based primary care, and has a presence in all 50 states.

The company went public earlier this year.

In 2019, KKR and an affiliate of Walgreens Boots Alliance bought BrightSpring for $1.32 billion. Now, Walgreens is exiting that investment, while KKR is doubling down.

BrightSpring was one of a few Walgreens investments that involved home-based care over the past half decade. It also acquired the post-acute technology platform CareCentrix, and invested over $6 billion in the home-focused primary care provider VillageMD.

Since its IPO, BrightSpring has been focused on an “integrated” approach to home-based care.

“As we’ve been saying, since the IPO, I believe in the next year, we’re really going to start to see the fruits of more and more integrated care in the organization,” BrightSpring CEO Jon Rousseau recently said. “We, obviously, have very clinically appropriate home health to hospice transitions, [and] some personal care being delivered to the same patients, therapy as well, … but we see an opportunity to really increase that in the future. It takes focus, so we’re investing in an integrated care team to do that.”

The post Investment Firm KKR Strikes Massive Deal To Acquire Shares Of BrightSpring From Walgreens appeared first on Home Health Care News.

Backed by the PE firm KKR, BrightSpring originally planned to raise $800 million in an IPO. In November of 2022, it ultimately decided against that course of action.

Now, an IPO – this time with a goal of raising $1 billion – is back in play. Bloomberg first reported the news, citing “people familiar with the matter.” The listing is expected to come to fruition in the fourth quarter.

BrightSpring has “re-engaged” Goldman Sachs and KKR’s capital markets division as lead bookrunners for the offering. Specifics and plans surrounding the IPO are not 100% ironed out yet, according to Bloomberg’s sources.

Based in Louisville, Kentucky, BrightSpring serves 350,000 senior and specialty patients daily in all 50 states. The company’s focus is on high-risk, high-need populations. Its patients have an average of 6 chronic conditions, according to the company. It provides 120 million hours of care per year, 75% of which is done so in the home.

In 2019, when KKR closed on its $1.32 billion purchase of BrightSpring, the latter merged with the pharmacy company PharMerica. At the time, the two companies had combined revenues of about $4.5 billion.

In 2021, BrightSpring acquired the home health and hospice company Abode Healthcare for $750 million.

In addition to KKR, Walgreens Boots Alliance (Nasdaq: WBA) – one of the retailers most involved with home-based care these days – is also a BrightSpring backer.

BrightSpring declined to comment on that matter.

Going public in home-based care

BrightSpring is a diversified home-based care services provider. After the onset of COVID-19, similar companies were performing very well on the public market. There were also rumors of several other privately held companies considering IPOs given the care-to-home trend taking place across the U.S.

Since then, the public market has mostly been hard on providers, particularly for those involved in home health and hospice.

LHC Group exited after UnitedHealth Group’s (NYSE: UNH) Optum acquired it in a deal that was finalized in early 2023. Now, Amedisys Inc. (Nasdaq: AMED) is also set to exit the public market to join Optum, so long as the deal clears regulatory hurdles.

Amedisys ultimately decided to sell due to multiple factors affecting its financial performance. Those factors include the Centers for Medicare & Medicaid Services (CMS) slashing home health payment, as well as the growing population of Medicare Advantage (MA) beneficiaries. MA plans generally pay far less for home health services than traditional Medicare does.

Enhabit Inc. (NYSE: EHAB) – another large home health and hospice provider – is currently conducting a strategic review that could result in a merger or sale. The company’s IPO only took place a little over a year ago, in June of 2022.

Reimbursement challenges aren’t just isolated to Medicare. In Medicaid, most states have begun paying more for home- and community-based services (HCBS). A recent proposed rule from CMS could also significantly affect public companies in that space, however.

HCBS providers could be forced to direct 80% of reimbursement to workers, which could be problematic, especially in markets where reimbursement is already lower than the national average.

Nevertheless, KKR and BrightSpring seem to be set on making that entrance onto the public market. Its diverse set of service lines could be enough to insulate it from regulatory and reimbursement challenges in one area or another, but that will remain unclear until the IPO is official.

The post Home-Based Care Provider BrightSpring Health Services Again Eyeing IPO appeared first on Home Health Care News.

Innovation, expansion and financial freedom can all be achieved through the backing of a PE firm. Like most things in the world, home-based care providers considering engagement with one will likely find there’s good and bad in the proposition.

What’s important to remember, however, is that not a single PE firm is exactly alike another. Therefore, it’s probably a mistake to take a broad brush to PE in general when considering the effect it could have on personal home care of home health care in the future.

“The one thing I learned is that … if you have seen one private equity company, you literally have seen one private equity company,” Ron Williams, operating advisor at Clayton, Dubilier & Rice (CD&R), said last week on a panel at the HLTH conference in Las Vegas. “There are a variety of different models.”

Williams was the CEO of Aetna from 2006 to 2010, and chairman from 2006 to 2011. He also formerly served on the former President Barack Obama’s management advisory board from 2011 to 2017.

On its end, CD&R is a very active health care PE firm. In terms of home-based care investments specifically, it just recently acquired the majority of Kindred at Home’s personal care and hospice assets from Humana (NYSE: HUM). That company will now become “Gentiva,” led by the former president and CEO of Kindred at Home, David Causby.

“When people say, ‘Well, what is it you actually do?’” Williams said. “The simplest way I find to explain it is: if we’re successful, we take good companies, and we make them great companies.”

For a lot of health care providers worried about their companies’ future, that sentiment is attractive for them. For one, survival often requires innovation, which means additional investment into the business that founders may be sheepish on committing to themselves.

Ari Medoff, the CEO of Arosa – a home care company that was acquired by the private equity firm Bain Capital Double Impact – talked about the need for innovation in home care models last week at Home Health Care News’ Home Care Conference.

“I think we desperately need new business models in our space,” Medoff said in Chicago. “I’m not just talking about trying to figure out how Medicare or some other third-party payer will pay the bill. A lot of energy goes into talking about that and dreaming about that, but I think it is incumbent upon us to think about how we bring value to clients in a different way that can lower bill rates and can raise pay rates.”

Close to 2,000 miles away, Adaeze Enekwechi – operating partner at Welsh, Carson, Anderson & Stowe (WCAS) – was commenting on the same point while explaining the value in a PE backer, which Medoff’s company now has.

“Quite frankly, it’s hard to think about innovation, expansion and growth without private capital” Enekwechi said. “The government will not fund everything we want to see happen.”

Enekwechi spent time with the Congressional Budget Office (CBO), the Medicare Payment Advisory Commission (MedPAC) and the White House Office of Management and Budget (OMB) as the head of health programs under Obama before joining WCAS in 2021.

WCAS, similar to CD&R, is in business with Humana on its value-based, senior-focused primary care venture. It also currently backs the value-based, home-focused kidney care company InterWell Health.

Particularly with health care investments and home-based care investments – given the clear need in the U.S. for those services – PE players defend their strategies by pointing to the incentives. Essentially, if an investment is made, it bodes for both parties if the selling company succeeds and grows.

“The market will tell us if what we’ve done with that company is good or not. The market will tell you right away,” Enekwechi said. “Because if your multiple is not valuable to any buyer, then that obviously was not a wise investment, or you didn’t do the right thing with the company.”

Home health care and personal home care haven’t always been targets for PE backers. The former has a “stroke-of-the-pen risk,” which PE firms have mostly gotten over, while the latter is just starting to gain significant interest for a variety of reasons.

But theoretically, partnerships could make sense from the above-mentioned perspective. A direct incentive line can be drawn from the PE backer, to the provider, to the patient or beneficiary.

“Doing well here is also doing well on behalf of your beneficiaries, retirees and the other folks who are depending upon us to hopefully help them meet their retirement objectives,” Christopher McFadden, managing director at KKR, also said on the panel at HLTH.

McFadden joined KKR in 2018. Prior to KKR, he was a senior advisor for Athyrium Capital Management and a managing partner of Canyon Healthcare Partners. He was also a partner at Health Evolution Partners and a managing director at Goldman Sachs.

KKR also backs a wide variety of health care companies, including the home- and community-based services provider BrightSpring Health Services.

PE concerns

What can sometimes worry companies about taking outside investment is what change it may lead to.

While good change is likely inevitable, the perceived bad change could also mean leadership changes and other restructuring.

“Change is not a bad thing,” Enekwechi said. “You’re going to have to think about a business development function that’s well outfitted and well run. You have to think about the size – do you need this number of people doing X, do you need this number people doing Y? I don’t want to say it’s a science; there’s an art to it. I think it’s foolish to think that you can basically retain 100% of what you have when you make an investment and expect to see a completely new set of results. You have to rethink the company.”

That’s why that leadership change is also sometimes necessary, Enekwechi said.

While one person may have been the right leader to take a company from $0 to $500 million, another might be needed to take it from $500 million to $1.5 billion, or from one site to many across the country.

“We have to acknowledge that change is painful,” Williams said. “And none of us like to change, I don’t like to change. But when you lead a company, the market tells you change – or else – and the ‘or else’ is unpleasant.”

The post What Home-Based Care Providers Should Know About How Private Equity Firms Think appeared first on Home Health Care News.

BrightSpring — formerly ResCare — merged with pharmacy company PharMerica as part of the deal.

While home-focused M&A activity has hit record levels over the past few years, the move to bring BrightSpring and PharMerica together is noteworthy because it blends the strengths of a diverse home care giant and a multi-state pharmacy powerhouse. Moving forward, executives say, a combined BrightSpring and PharMerica will have a heightened ability to manage complex medication regimens and monitor adherence on a regular basis in individuals’ homes.

Up to 26% of hospital readmissions are preventable and related to medication issues, past research has found.

“Greater independence, improved health outcomes and reduced hospitalizations all depend on three things to be present — non-clinical support services, daily medication optimization and clinical monitoring and interventions when required, which is what we are focused on providing to deliver value as a combined company,” former PharMerica CFO Bob Dries said in press release.

Dries will serve as president of PharMerica under the combination. BrightSpring’s Jon Rousseau will lead the overall enterprise as its CEO.

The merged company will have combined revenues of about $4.5 billion and serve more than 300,000 clients daily across 47 states, in addition to Puerto Rico and Canada. It will maintain a headquarters in Louisville, Kentucky, where both BrightSpring and PharMerica are based.

BrightSpring is one of the country’s largest providers of diversified home- and community-based health services for seniors, as well as non-seniors and individuals with intellectual or developmental disabilities. Expanding the company’s clinical and care management capabilities has been a priority for Rousseau ever since he took over as CEO in 2016.

The merger with PharMerica is yet another example of that, he previously told Home Health Care News after plans were first announced.

“What we’re trying to do is have a class of assets in our target geography to give us that capability set, ultimately working in a highly integrated way to the benefit of our client and the benefit of our company,” Rousseau said. “We really believe that pharmacy is essential and, in many ways, the front lines in keeping patients out of the emergency room and out of the hospital.”

PharMerica Corporation is a provider of institutional and community-based pharmacy services for the long-term care, senior living, hospital, home infusion, behavioral, specialty and oncology pharmacy markets. The company has operations in 96 institutional pharmacies, 20 specialty home infusion pharmacies and five specialty oncology pharmacies across 45 states.

Walgreens in the background

In total, there were at least 715 private equity health care deals that closed by the middle of December 2018, according to PitchBook data. KKR was a part of the biggest — a $9.9 billion acquisition of Envision Healthcare.

KKR’s deal for BrightSpring with the Walgreen Boots Alliance affiliate is likewise one of the largest PE health care deals over the past 12 or so months, ranking just below the $1.4 billion Humana Inc. (NYSE: HUM), TPG Capital and Welsh, Carson, Anderson & Stowe paid for hospice provider Curo Health services.

“Today marks the start of a new and exciting chapter for BrightSpring and PharMerica,” KKR member Max Lin said in a press release. “We look forward to working with the team on the combined company’s next phase of growth and development.”

ResCare — under the private equity ownership of Onex Corporation — rebranded as BrightSpring Health Servies in August. Shortly after rebranding, rumors began circulating that Onex was looking to sell the company.

Broadly, the BrightSpring-PharMerica merger reflects the growing trend of health care investors seeing value in the “touchpoints” home-based care providers bring to the table, Stoneridge Partners President Rich Tinsley told HHCN.

Stoneridge Partners is a health care mergers-and-acquisitions advisory firm involved in the brokerage of home care, hospice and behavioral health agencies.

“The more you ‘touch’ an individual and the more you can understand them where they are, the longer you can keep them out of a higher cost setting,” Tinsley said. “Managing that pharmacy piece is a really big deal.”

From an M&A standpoint, it will be interesting to follow the BrightSpring-PharMerica enterprise, especially as KKR eventually seeks an exit, perhaps opening the door further for Walgreens through its affiliate, currently a minority investor.

Walgreens has already made its interest in the aging-in-place discussion known. In June, the company teamed up with Humana to pilot senior-focused health clinics located in Walgreens stores in Kansas City, Missouri.

“KKR will want to exit in three to seven years. What will Walgreens want to do then?” Tinsley said. “I can imagine Walgreens being the majority owner at some point, as all retail health care folks are trying to figure out how they can get into the home.”

The post BrightSpring, PharMerica Merge in $1.32 Billion Deal appeared first on Home Health Care News.

Overall, there were at least 715 PE deals that closed by the middle of December, according to PitchBook, which provides data and other insights on the private market through a variety of software applications. Those deals had a combined value of nearly $104 billion, largely thanks to several individual ones that topped the $1 billion mark.

In comparison, private equity firms only completed 672 health care deals in 2017 and a meager 200 in 2009, statistics from PricewaterhouseCoopers’ Health Research Institute show. Health care companies looking to sell non-core business units or looking to strengthen their resource pool to compete in a highly competitive market are among the many drivers of PE’s expanded role.

There will be at least 747 health care deals involving private equity buyers or sellers in 2019, the Health Research Institute projects.

“Private equity investment in health care isn’t going to single-handedly improve care quality, enhance the patient experience or reduce health care costs to consumers,” Health Research Institute analysts maintain. “But it likely is fueling the efforts already in place. Private equity firms bring capital and experience from other industries that can contribute to the health care industry’s efforts to rein in costs and achieve better outcomes.”

Private-equity powerhouse KKR’s $9.9 billion deal for Nashville-based Envision Healthcare Corporation, one of the largest doctor-staffing companies in the country that also operates a handful of in-home care entities, was the largest PE health care deal. Announced in June, KKR officially completed the deal in October.

The $4.1 billion acquisition of Kindred Healthcare by Louisville, Kentucky-based insurance giant Humana Inc. (NYSE: HUM) and PE groups Welsh, Carson, Anderson & Stowe and TPG Capital was the fourth-largest private equity health care deal last year. Under terms of the deal, finalized in July, Humana acquired 40% of Kindred at Home’s business, with the two PE groups acquiring the remaining 60%.

Humana, TPG Capital and Welsh, Carson, Anderson & Stowe also teamed up for the eighth-largest PE health care deal — their $1.4 billion acquisition of Mooresville, North Carolina-based hospice provider Curo Health Services. The deal closed in July, also with Humana gaining a 40% stake in the business under terms of the deal.

Here is the full top-10 list of PE health care deals from 2018, originally published by Forbes using PitchBook data:

1. Envision Healthcare ($9.9 billion) | KKR
2. Athenahealth ($5.7 billion) | Veritas Capital, Evergreen Coast Capital
3. LifePoint Health ($5.6 billion) | Apollo Global Management, ATP Private Equity Partners, RCCH HealthCare Partners
4. Kindred Healthcare ($4.1 billion) | Humana; TPG Capital; Welsh, Carson, Anderson & Stowe
5. American Medical Response ($2.4 billion) | Air Medical Group Holdings
6. Sound Physicians ($2.15 billion) | Revelstoke Capital Partners, Athyrium Capital Management, Summit Partners, Silversmith Capital Partners
7. Lifescan ($2.1 billion) | Platinum Equity
8. Curo Health Services ($1.4 billion) | Humana, TPG Capital; Welsh, Carson, Anderson & Stowe
9. Juice Plus ($1.235 billion) | Altamont Capital Partners
10. Analogic ($1.1 billion) | Altaris Capital Partners

While the above list only highlights Kindred Healthcare and Curo Health Services, there were dozens of notable home-based care deals throughout 2018 by PE firms.

SYNERGY HomeCare, a franchisor with about 300 locations nationwide, was sold to private equity firm NexPhase Capital for an undisclosed sum in April.

In November, Pharos Capital Group made a majority investment in Charter Health Care Group, a California-based provider of post-acute care services, including hospice and home health care.

In October, Bain Capital Double Impact announced it had acquired and planned to combine Arosa and LivHome to create a new national in-home care provider.

As private equity becomes increasingly involved in health care, some have raised questions regarding the motives of firms and their willingness to realistically balance profits with high-quality, affordable care. Those skeptics include James Carey, the executive director of Association of Independent Doctors.

The post Largest Private Equity Health Care Deals of 2018: Kindred, Curo Make the List appeared first on Home Health Care News.

A new study found that older adults with higher financial literacy tend to have lower hospitalization rates. The study, published in Medical Care, underscores an important determinant of health outcomes as most providers are continuing to seek ways to reduce hospitalization rates and costs.

While many health care providers have turned to ride-sharing companies like Uber and Lyft to help them connect better with patients and reduce missed appointments, seniors in Arizona reportedly are having a hard time catching a ride. That’s because many seniors don’t own smartphones to access the apps and the rise of ride-sharing has coincided with a downturn of available traditional taxis, AZ Central reported.

Most read

Amazon (Nasdaq: AMZN) has been looking for ways to break into the health care space with home care stakeholders watching their every move. However, the ecommerce retail giant’s B2B service line, Amazon Business, is already serving a million business customers and streamlining the supply chain process.

Encompass Health (NYSE: EHC) is executing on a new playbook to drive collaboration between its inpatient rehabilitation facilities (IRFs) and home health agencies, CEO Mark Tarr told Home Health Care News.

Private equity powerhouse KKR has acquired Nashville-based Envision Healthcare Corporation (NYSE: EVHC), one of the largest doctor-staffing companies in the United States with roughly half a dozen in-home care entities under its umbrella, in a $9.9 billion deal.

Written by Amy Baxter

The post Must-Read News: Financial Literacy Tied to Lower ER Rates appeared first on Home Health Care News.

The $9.9 billion deal, announced Monday, is one of the biggest by a private equity firm in the past couple years, easily placing it among the ranks of JAB’s $7.5 billion play for bakery chain Panera Bread or Sycamore Partners’ $6.9 billion purchase of office supplies giant Staples. The all-cash acquisition, which includes debt, comes exactly one week after KKR sold back half of its stake in Baton Rouge-based home health provider Amedisys, Inc. (Nasdaq: AMED) for about $178 million.

“Envision is a leading provider of physician-led services in a health care system in which physician-patient interactions have a pronounced impact on nearly all health care decisions,” Jim Momtazee, head of KKR’s health care investment team, said in the announcement. “We are excited to partner with the outstanding team … to help build upon the strong foundation in place and accelerate Envision’s growth going forward.”

The result of a 2016 merger with AMSURG Corp., Envision Healthcare offers wide-ranging physician-led, ambulatory and post-actute services to more than 1,800 clinical departments in health care facilities across 45 states and Washington D.C. The company owns and operates 261 surgery centers and one surgical hospital. It also offers in-home care services though its Evolution Health business and several wholly or partly owned subsidiaries, including Ascension Health at Home, Care Connection of Cincinnati, Gem City Home Care, Guardian Healthcare, Millennium Home Care and Valley Health Home Care.

Ascension Health—a national partnership between Ascension and Evolution Health formed in 2014—was the the 33rd-ranked home health agency in terms of market size in 2017, according to the LexisNexis. The partnership between Evolution Health and Ascension Health includes Ascension-affiliated home health, hospice, home infusion therapy and private-duty services.

Evolution Health had about 2 million care encounters in 2016, according to an annual report from the business. Combined, Evolution Health and Ascension Health at Home had a total workforce of about 4,000 people in 2016, about 37% working in Evolution Health operations and 63% in Ascension Health at Home joint venture operations.

Kirk Allen currently serves as Evolution Health’s president. He also serves as president of Ascension Health at Home.

KKR and Envision Healthcare did not respond to Home Health Care News’ requests for comment as of publication.

It is unclear exactly how much of Envision Healthcare’s revenue is derived from its home health operations. More than half of the company’s revenue comes from emergency department and hospitalist services, according to U.S. Securities and Exchange Commission financial filings. Anesthesiology services account for 28% of the Envision Healthcare’s revenue mix, with radiology services and children’s services combine for about 10%. “Office based, surgery and other” make up the remainder, about 8% in total.

Envision Healthcare’s net revenue in 2017 was $7.8 billion, according to financial filings. Despite the high revenue total, it recorded a loss of about $228 million.

KKR’s acquisition of Envision Healthcare follows the recent pattern of private equity investors buying into health care, especially when it comes to in-home care and hospice companies. Throughout the last two years, there have been more than 32 private equity investments into the home health and hospice spaces, according to proprietary data from The Braff Group.

Envision Healthcare has been under fire in recent months after a study conducted at Yale found that hospitals where Envision’s EmCare unit operated appeared to charge more out-of-network bills for at least one insurer. The company had been looking to make a move for the past seven months in order to enhance shareholder value, reaching out to more than two dozen potential buyers before agreeing to terms with KKR.

Written by Robert Holly

The post Home Health Businesses Acquired by KKR Through $9.9 Billion Envision Deal appeared first on Home Health Care News.

The shares represent half the holdings of Amedisys by KKR, a global investment firm based in New York City. The shares were purchased at 96% of their closing price on June 4, 2018. KKR will maintain its presence on the board of directors at Amedisys for at least 12 months, according to a press release issued Monday.

The transactions will be immediately 6% to 7% accretive to earnings per share. The deal will be financed through $140 million of available cash, with the remainder of the $178 million funded by borrowing under the company’s existing revolving credit facility.

“Our ability to opportunistically deploy capital in an accretive manner, while maintaining extremely low leverage and significant borrowing capacity to finance further acquisitions, makes this a great deal for our shareholders and our company,” Amedisys CEO and President Paul Kusserow said in a statement. “This transaction is a strong signal of confidence in our company’s continued attractive growth prospects.”

The transaction comes as Kusserow recently stated he was “frustrated with the market,” as a result of high valuations for hospice and home health care assets.

Amedisys ended 2017 with $120 million of cash on hand, and the company was “anxious to put that to work,” CFO Scott Guinn stated at the Bank of America Merrill Lynch 2018 Health Care Conference on May 16, 2018.

“While accretive acquisitions remain our first priority for capital deployment, we view this transaction as the best use of capital given current acquisition multiples and the confidence we have in our business,” Kusserow said. “Our acquisition pipeline remains active, cash flow is strong and we have ready access to capital markets.”

Amedisys is also in advanced discussions to significantly expand its borrowing capacity with lenders under its secured credit facility to allow it to capitalize on its active acquisition pipeline.

Following the transaction, Amedisys will have approximately 32 million outstanding shares of common stock. The company’s available cash will be approximately $20 million and its outstanding borrowings under the credit facility will be $128 million, leaving a net leverage ratio of approximately 0.7x.

Amedisys stock was trading up slightly, at above $77 per share in after-hours trading Monday.

Written by Amy Baxter

The post Amedisys Buys Back $178 Million in Stock appeared first on Home Health Care News.

Monday, Kindred solicited its newest proposal to Gentiva in response to the company’s rejection last week of its previous offer to acquire the company for $16 per share—an 87% premium to Gentiva’s closing share price on May 14, 2014, the day before Kindred made public its proposal to acquire the company.

In response to recent news that Gentiva is entertaining a new offer of $17.25 from a “recognized owner, operator and investor in the sector,” Kindred is now proposing to acquire 100% of Gentiva’s outstanding shares for the same price as the other unnamed suitor of $17.25 per share, according to a letter sent Monday by Kindred CEO Paul Diaz to Gentiva Executive Chairman Rod Windley and CEO Tony Strange.

“Specifically, we confirm that Kindred would be prepared to enter into a negotiated agreement to acquire all of the outstanding shares of Gentiva for $17.25 per share, provided that we are permitted to conduct diligence to confirm such additional value is warranted,” wrote Diaz.

Though still unnamed, analysts suggest the undisclosed “recognized” owner who proposed the alternative offer may be one of several private equity firms that has a presence within the home health space.

“While the company did not specify who the offer came from, we believe it is likely a private equity firm that owns a home health and hospice business, possibly Cressey & Co. or GTCR,” stated Kevin Ellich, a senior research analyst with Piper Jaffray, in a note released Thursday.

Under Cressey & Co.’s belt is Encompass Home Health & Hospice and Hospice Compassus. Both providers offer their services in select states nationwide across more than 100 branch locations. The company boasts a firm with experienced principals who have invested and managed over $1 billion of healthcare investments.

GTCR, a Chicago-based private equity firm that manages more than $8 billion in private equity and mezzanine capital, commands a portfolio includes Curo Health Services, a hospice provider that operates in 10 states, according to the company’s website. Curo is also headed by former Amedisys, Inc. (NASDAQ:AMED) Chief Operating Officer Larry Graham.

“There is also a possibility the offer came from KKR and would use Amedisys as the operating vehicle, although the combined leverage of the two companies seems like a deterrent for such a deal,” Ellich stated in the Piper Jaffray report.

Amedisys, of which the report notes KKR owns approximately 15%, has had its name circulated before amid the ongoing drama between Gentiva and Kindred.

In response to a previous offer snub from Gentiva at the end of June, Kindred’s Diaz sent a letter to Gentiva’s Windley and Strange, urging them to reconsider their rumored acquisition of Amedisys.

“We are concerned that, while refusing to discuss Kindred’s highly attractive cash offer, the Gentiva board may be pursuing a course that would disenfranchise its shareholders through a value-destroying and highly levered transaction with Amedisys,” Diaz wrote.

Lastly, another possible suitor who may likely be in the contest for Gentiva also includes Formation Capital, a private equity firm that maintains a national presence with over $4 billion of managed investments in healthcare real estate comprising over 60,000 beds in 35 states.

An investor primarily in the senior housing and post-acute care industries, Formation Capital in 2007 completed its acquisition of Genesis HealthCare Corporation in a total enterprise transaction value of approximately $2 billion.

Prior to Kindred’s announcement Monday, Piper Jaffray sees the alternative proposal of $17.25 as attractive. But now that Kindred has equaled that amount, the ball is now in the court of Gentiva executives.

Written by Jason Oliva

The post Private Equity Pegged as New Multi-Billion Dollar Gentiva Bidder appeared first on Home Health Care News.